While there has been a shift in care from hospitals to outpatient facilities (like ambulatory surgery centers), inpatient services still account for about half of a hospital’s patient revenue. In addition, on average, more than one-third of hospital payor days are for Medicare patients.
So, as people in the U.S. continue to age, information on inpatient hospital stays is important to understand patient populations, service line requirements, and financial management.
What is a DRG in healthcare?
Diagnosis-related groups (DRGs) are used to classify patients and document their hospital stay. Medicare sets a standard amount to pay for each hospital case and adds a payment weight for each DRG.
Medicare payment weights are based on several factors, including:
- Case severity
- Geographic location
- Proportion of low-income patients in the hospital’s service area
- Patient age, sex, and comorbidities
The Definitive Healthcare HospitalView product tracks Medicare inpatient DRGs for more than 5,200 U.S. hospitals. DRGs are sourced from the Medicare Standard Analytic Files (SAF).
How many DRGs are there?
In the Definitive Healthcare HospitalView product, there are 757 DRG codes listed for calendar year 2022.
The table below reviews the top DRG codes for Medicare inpatients in 2022.
Top 20 most common DRGs for 2022
||Percent of total DRG diagnoses
||SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W MCC
||HEART FAILURE & SHOCK W MCC
||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC
||SIMPLE PNEUMONIA & PLEURISY W MCC
||PULMONARY EDEMA & RESPIRATORY FAILURE
||SEPTICEMIA OR SEVERE SEPSIS W/O MV 96 OR MORE HOURS W/O MCC
||MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC
||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC
||KIDNEY & URINARY TRACT INFECTIONS W/O MCC
||RENAL FAILURE W MCC
||G.I. HEMORRHAGE W CC
||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC
||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC
||RENAL FAILURE W CC
||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC
||KIDNEY & URINARY TRACT INFECTIONS W MCC
||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC
||MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC
||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC
Fig 1. Data from Definitive Healthcare HospitalView product and sourced from the Medicare Quarterly Standard Analytic Files (SAF) for calendar year 2022. Accessed October 2023.
What is the most common DRG?
Septicemia, also known as sepsis, DRG code 871 is the most common inpatient DRG, accounting for 7% of diagnoses. Sepsis is a severe blood infection that is most often contracted via a wound infection and is often considered a hospital-acquired condition (HAC). If left untreated, sepsis can lead to organ damage, organ failure, and even death.
Additional common DRGs on the list include:
- Heart failure, DRG code 291
- Respiratory infections and inflammations, DRG code 177
- Psychoses, DRG code 885
- Simple pneumonia and pleurisy, DRG code 193
- Pulmonary edema and respiratory failure, DRG code 189
Looking for more DRG data? Explore the DRGs with the highest readmission rates or the top DRGs by diagnosis volume.
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